Saturday, October 13, 2007

THE CROCK OF CHRONIC LYME DISEASE

My apologies for not writing in so long. There are many things I read that I want to blog about, but then I watch television.

I want to get right back on the train with a round of applause for one of the best articles I have ever read in the New England Journal of Medicine. Their critical appraisal of “Chronic Lyme Disease” (and I LOVE the quote marks) was short and sweet, and there are so many takeaway messages.

The first, of course, is that there is NO good evidence of any such entity in the medical lexicon. What I mean to say is, it is NOT A RECOGNIZED INFECTIOUS DISEASE! Here’s a quote from the Infectious Disease Society of America website:

an extensive review of scientifically rigorous studies and papers available to date, has determined that there is no convincing biologic evidence to support a diagnosis of chronic Lyme disease after completion of the recommended treatment

But don’t tell the chowderheads at so-called “support groups” like this one. They are all over the country (even in places where Lyme is NOT endemic), composed of rich people, and have NOTHING BETTER TO DO but use the internet to obsess over their pathetic lives.

Apparently, for the believers, you do not even need to have a positive antibody test against Borrelia burgdorferi to make the diagnosis., because it might not be valid unless done by a “specialty laboratory”, which is, of course, a scam, since they are performing tests that are not even validated or supported by the FDA, and are using criteria that are based only on their own fantasy values.

This is the second takeaway message: that there’s a sucker born every minute. In this case, the sucker is the poor sap (or self-important “expert” patient) who seeks out the “Chronic Lyme specialist” (laugh heartily, men-of-science) for weeks, months, even YEARS of chronic antibiotic therapy which is proven to do NOTHING except cause complications of side effects and catheter infections (one resulting in DEATH, according to the article).

The article goes on to discount every theory that the “Chronic Lyme” fraudsters purport. But the most disturbing part of the article comes near the end. Here’s a quote:

The attorney general of Connecticut has begun an unprecedented antitrust investigation of the Infectious Diseases Society of America, which issued treatment guidelines for Lyme disease that do not supportopen-ended antibiotic treatment regimens

An attorney general is actually pursuing legal action against an academic society because they disagree with his unscientific view of a bogus clinical entity that is disproved by science. Saying I am shocked and nauseated does not begin to describe my true feelings. How is this possible in 2007? Why are lawyers pretending to be scientists??? Does this guy own a bunch of these “specialty” clinics or something?

That’s the final takeaway message: science is now being dictated to by people who have absolutely no idea what they’re talking about, and aren’t interested in real research.

Thank you Henry M. Feder, Jr., MD er al, and the Ad Hoc International Lyme Disease Group for the article of the year!!

My only hope for you is that you come into contact with multiple ticks over a very long period of time. You will of course not see the ticks since they are so small. You will not develop the rash or the bull's eye ring. But you will gradually begin to feel worse and worse. You will be so fatigued you will not be able to funcction, you will ache everywhere including your eyes and teeth. You will be sensitive to light and sound. Then one day you will remember a walk in the woods, or having gone camping, or maybe as all good docs do....go golfing. Then you will remember brushing something off your legs or clothing. And you will begin to wonder. You will go to many of your fellow collegues, they will not know what is wrong with you. You will change cognitively, you won't be able to spell or recall words as you used to. You will become concerned about continuuing to practice medicine. You will eventually concede to being tested for Lyme and the tests will come back negative. You become worse. Friends and family don't understand what is wrong with you and why you complain so much. You will get diagnosed with Lupus, or ALS, or chronic fatigue and a list of many other things. The treatments you receive won't work. You have to give up practicing medicine. Meanwhile, somewhere in the future the truth becomes known about Lyme being a chronic disease and you remember your blog. By this time you are almost completely incapacitated and bedridden. You turn for help, it will take years to feel "better" again. You notice that the abx do relieve your symptoms. Hopefully, you will feel some regret. Hopefully, you will not have hurt too many people when you were practicing medicine.

You don't want others to assume you are rich (your Sept. 16 post), please don't assume the same of Lyme patients.

I, for one, got myself off of 4 months of welfare, recovering from a Lyme relapse. My first bout was textbook -- exposure risks, positive Lyme tests from Quest, 1 month of doxycycline didn't work, 1 month of Ceftin was better, left to recover slowly, which took a year.

Two years later, no exposure risk, worse symptoms. Treated for Lyme, then 6 weeks for babesia, and had an abrupt turnaround.

I still have symptoms, but am well enough to work 3 jobs to stay afloat and ace grad school to prepare for my future. A future I can kiss good-bye if I should relapse again, and the only ones that can help me are people like you.

You speak of "take away messages" ... I'd like to share one with you. True medical professionals who are well trained strive to keep an open mind.

Do you truly have ANY idea what Lyme Disease has "taken away" from people (wealthy & not)? As you practice in the NYC area, you'd be wise to open your mind.

When you grow up and become a real doctor, you are sure to see many cases of chronic Lyme in your wealthy family & friends after their summer weekends on Long Island. Hopefully you will recognize that they have been misdiagnosed by your peers.

Try being a positive contributor to good science & better testing rather than joining a sinking ship full of fools out to further their own financial & egotistical gains.

I am not a doctor, but I am a scientist, a published one at that, and I know how to read scientific studies. I know how to interpret the results, and I know the difference between an article and a study. I know the difference between fact and opinion.

Halperin, Wormser and all these crooked criminals may be able to convince the laymen with their "spin" on things, but they cannot fool me. I want to expose them, as a scientist, stating that they twist the facts from the studies to suit themselves. What they say is opinion, and has no factual basis.

Anything in a newspaper usually is not fact, but someone's opinion. When a researcher makes conclusions based on a study, and then another scientist picks and chooses certain parts of that study and twists it into a pretzel, that is criminal, unethical, and totally unprofessional. They are really discrediting themselves by doing this.

If I had any doubts about the lyme controversy before, they are completely squashed now because of the behavior of these unethical doctors that I am witnessing.

Unfortunately, it seems like the masses don't see what they are doing, and only a scientist or someone familiar with research studies can understand.

Maybe you should stop watching television and start reading some of the lyme disease studies.

You ask "Why are lawyers pretending to be scientists??? Does this guy own a bunch of these “specialty” clinics or something?"I ask, "Why are doctors pretending to be scientists or vice versa?" Gee, could it be because they have documented vested financial interest in supposed Lyme Disease cures? Be great to see some of those buckets of research dollars actually help the patients!

You would be at the top of my list of "quacks". I, unlike you, am far from being rich, and have obviously a lot more interests than you also, that I can only hope to get back to one day. My adult children have never even seen me healthy, and I was once healthy enough to train & show horses. There are many nurses and real doctors that have either contracted this themselves or have a close family member that has contracted this insidiuos disease. It would do you well, and your patients(*shudder*) if you would be intellegent enough to do your own research before concluding anything. Or are you like those "doctors" that presumed that they were powerful enough to know what was truly going on within Terri Schivos'(spelling?)brain from a video?

This is an opinion piece by Dr. in consulting collaboration with other experienced colleagues.

It is not intended to reflect an exhaustive critique of the many shortcomings of the “Feder” paper, but rather an attempt to highlight the most glaring incongruities and perplexing logic flows contained within what is considered a shameful and politically-motivated article.

The purpose of this critique is to place disparaging opinion about persistent disease associated with Lyme Borreliosis on full exhibit.The subject of “Chronic Lyme Disease” was once again presented in a prominent journal setting in a recently published “review” in the October 4 NEJM article by Feder et al.

As seen in several previously published reviews, opinions, and guidelines, the tenor of the publication is dismissive to physicians who feel that Borrelia burgdorferi, the causative agent of Lyme disease, may be responsible for persistent illness which requires long-term antibiotics and a myriad of other treatment considerations and measures.

It seems to patronize the opinions of these physicians, opinions which are backed by hundreds of scientific publications and galvanized by countless clinical encounters with desperate and marginalized patients. Published “reviews” on Lyme disease, similar to the Feder article, seldom offer any new or credible insight into clinical or scientific issues, and therefore their purpose and timing must be questioned. This article clearly echoes the stilted logic and highly suspect content promoted by the portion of the 2006 IDSA Guidelines which dealt with this subject matter and whose authors may come under anti-trust investigation.

The repetitive arguments promoted by a select group of researchers and/or self-proclaimed “ad hoc” committee members –“the Lyme Cabal”, as we will refer to them, includes the high-ranking members of the CDC’s Vector Borne Branch, Johnson and Mead, and do nothing to further our understanding of what is making our population chronically ill.

In the absence of new ideas and with a history of rejecting meaningful dialogue with those who may disagree with them, Feder and associates appear to simply reshuffle authors and rearrange their template of imperial arguments for this most recent article. Again they employ the same indecipherable, distorted, and circular logic which they have displayed in the past, and appear to play favorites with their facts.

Many of the authors cited are known to have ties to patented business ventures dealing with, among other things, future testing and vaccine development in Borreliosis-related ventures. We have serious concerns about propriety and integrity issues for both the Lyme Cabal constituents and for the NEJM, which has a heretofore irreproachable standard of excellence in publishing medical science.

We also express serious concerns about the health of our population in terms of the continuing scientific “ambiguity” surrounding this disease complex, which we term Lyme Borreliosis Complex (LBC).

The review begins by indicating an important fact – that Lyme disease is a serious public health problem which is “complex”, but the tone of the article immediately thereafter becomes and remains, dismissive. LBC is trivialized through consistent application of journalistic phrasing techniques designed to give the reader a sense that the authors are annoyed that there is a fuss about this issue, and that their views have not been accepted without reservation.

Examples of these methods of literary intimidation and the abusive misuse of factual material are scattered throughout the text and are briefly portrayed as follows:a) This “serious public health threat” which is “complex” will “usually respond well to conventional antibiotic therapy.” The committee fails to provide evidence of what response is measured and by what methods.

b) They further state that a “minority of patients” have symptoms which remain after “resolution…after antibiotic treatment.” Again, this assumes that all patients are diagnosed and treated, which is simply not fact, and again this statement defaults to the committee’s inflexible criteria for diagnosis and treatment.

c) The committee further considers symptomatic illness as “usually mild and self-limiting”, and defines these patients as having “post-Lyme disease syndrome”, an arbitrary term adopted by the Feder camp years ago and thoroughly associated with ill-defined, non-organic illness through repetitive indoctrination with this brand of pseudo-scientific jargon on the unsuspecting medical community.

“Mild and self-limited” is counter to the characterization of numerous other reports, and contradicts the authors’ opening remarks of a “serious and complex” illness. The terms “mild and self-limited” are subjective, and craftily inserted to prejudice the biased opinions which follow.

d) After the initial paragraph, the word “complex” is no longer mentioned, as if the authors feel readers will forget the reference as it is plowed under by subsequent disparaging remarks.

e) The committee stated that their review is “not the objective manifestations of late Lyme disease but rather the imprecisely defined condition referred to as ‘chronic Lyme disease.’”

i. ‘Objectivity is in the eye of the beholder. The more skilled and experienced the observer becomes, the better the tools available with which to measure; the better the understanding of the elements which comprise the universe of the subject matter at hand, the more “objective” the manifestations of the illness complex will become.

ii. The committee is derelict in not being more forthright about issues of objectivity; if objective measures are wanting, why not make efforts to improve them? The practice of medicine is suffering mightily as our practitioners increasingly rely upon guidelines and “cookbook” medicine, and not on what the patient communicates. We physicians are becoming more robotic, and why is that so? The physician must constantly listen to, and learn from the patient, especially when “testing” fails both provider and patient.

iii. The committee stumbles over the precise definition of an illness they initially state is “complex” and proceeds to wantonly blur the debate further by talking about, “not the objective manifestations of Lyme disease”, but rather “chronic Lyme disease”. This is classic double–speak on their part.

f) The committee targets a “small number of practitioners”, not a subtle reference, the terminology of which is assuredly designed to reduce the number and significance of those with opposing viewpoints. The committee appears to mock physicians who “suggest” that persistent B. burgdorferi may require long-term antibiotic treatment, or that it may be “incurable”. They do so in such manner that suggests a whimsical allusion to futility, and implies in parallel analogy that patients who embrace this view are equally futile in their thinking.

g) Declarative and unsubstantiated statements dominate the “review” as in “the opinion of the committee is that Lyme disease includes a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to B. burgdorferi infection”.

First, note that this is an opinion but, in the setting of the Lyme Cabal publishing in the NEJM, this opinion equates to dictum and also, in our collective opinion, equates to an abuse of power by those who hold power in this setting. The lack of “evidence” reference, which glides so easily on the NEJM page, is easily countered by well-documented literature references indicating that the world at large is held hostage to unreliable and stifled testing which severely limits the ability of the practitioner to provide laboratory data in support of this aforementioned “complex illness”.

h) In the very near future, we predict that many of the Lyme Cabal will find it hard to explain the more than 200 patents they hold for better testing, vaccine development, and other business interests in the expanding universe of Borreliosis-related disease.

Further, it may prove exceedingly difficult for the Cabal to explain why their involvement with these patents have been largely undisclosed, when the science at hand could have benefited the untold thousands whose lives have been unalterably changed by this chronic illness.

i) Late in the publication, the committee uses the political and inflammatory term “Chronic Lyme Disease” as the heading of a new section, instead of their preferred term, “late Lyme disease”. We ask the obvious question of why the choice to begin a section with something the committee says does not exist.

j) The committee further makes vague and imperial comments about those diagnosed and treated for Lyme disease, as somehow being “substantively” different than those with other “recognized” infectious diseases. We are disturbed that a NEJM editorially-approved article would accede to a reference which equates to “intellectual cement” in academic medicine. At what point did the US academic universe decide that they had a handle on the mysteries of medicine? Over 90% of the most prominent chronic illnesses, e.g. MS, RA, Crohn’s, etc., have no know cause. This is hardly a position from which to exude scientific arrogance. Diagnoses are, and always will be, integrally associated with varying clinical criteria, test interpretations, and physician judgment. Testing was designed to serve the will of the clinician and now it seems that the tail wags the dog. Generational change in medicine historically shows that 50% of what we hold as fact today will change, but which 50%?

k) A disclaimer by an organization is an attempt by the rule makers to absolve all recriminations in perpetuity. To wit, as our authors and their alter egos at the IDSA suggest, (and as some of the committee’s authors who took part in the 2006 Lyme Guidelines stated): “It is important to realize that guidelines cannot always account for individual variations among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations”.

Why then would these committee members attempt to minimize the role of physician judgment in the diagnosis of any illness, especially a disease with the devastating impact of persistent Lyme disease? Clearly the committee is de-emphasizing clinical judgment and experience because they don’t fully appreciate the roots of their discipline – the patient. This is a highly disturbing and dangerous thought for the profession of medicine and for the population which it serves.

l) The committee criticizes the “lines of reasoning” to support a diagnosis of Lyme disease in those who do not show antibodies against B. burgdorferi in serum, particularly given the “the well-known immunogenicity of lipoproteins”. They claim these “theories” of antibody negativity with LBC are not well-supported by scientific data. They fail to acknowledge that the testing reagents used in traditional labs are limited to only one strain (B31) in a disease in which multiple Borrelia burgdorferi strains may play a role.

They ignore the well-documented altered life forms of Borrelia species, (e.g. CWD forms, cysts, and blebs), none of which manifest lipoproteins. They fail to acknowledge the intracellular habitat of both helical and cyst forms, and the disturbing ability of the B31 spirochete to penetrate a series of neuronal and glial cell lines, as described in the 2006 Livengood CDC paper published in the summer of 2006. They fail to hypothesize or consider the notion that patients with LBC may have highly dysfunctional innate and adoptive immunologic effects.

As if not satisfied with yet another highly creative and biased interpretation of the data, the authors then turn to criticize “specialty labs” as not “FDA approved”. The FDA, which by the way acknowledges that current testing is unreliable, has nothing to do with credentialing labs unless a product is marketed, a convenient oversight by the authors.

This “shoot the messenger” approach ignores the highly suspect and arbitrary manipulation of data and policy which took place at the 1994 Dearborn meeting and left the world without Osp A and B bands as qualifying criteria for diagnosis. This is a particularly mystifying situation since the ill-fated and ill-conceived LYMErix vaccine promoted by several of the Lyme Cabal was based on the Osp A, or kda band 31, lipoprotein antigen.

Most significantly, the authors fail to mention that much of the research done by several of the authors of their own committee, (when closely examined), supports the opposite view of what they express. Perhaps they should go back and re-study their own, earlier research.

As stated previously, many in the Lyme Cabal are involved in various side-interests which include, but are not limited to, the patenting of diagnostic tests and/or components thereof, which we have referred herein. Therefore, we and others are concerned that these individuals might have a vested interest in dismissing any diagnostic or treatment modalities contrary to their “recommendations”..m) The committee uses “shock value” terminology to describe a minority group who treat Lyme disease – a handful of practitioners utilizing “unconventional” or “dangerous” methods to treat Lyme, as if they are the collective majority. The mainstream of providers does not fit their characterization, so these inferences are wholly unsubstantiated, unwarranted and malicious.

To this end, the committee has a history of promoting the term “medical quackery” at every opportunity because its use resonates loudly as an alarm to the public. The authors know that libelous remarks directed against specific physicians or groups are very difficult to prosecute and that their public indignation makes for good journalistic copy without fear of reprisal. . n) Further, the committee states that “no other spirochetal illness including…tertiary syphilis is managed in an analogous fashion.” Syphilis, caused by treponema pallidum, has a formidable and sinister history for causing human illness in past centuries, and in recent times has experienced a renaissance associated with the HIV/AIDS pandemic.

Unlike Borrelia burgdorferi, treponema pallidum has only one host, the human, whereas Borrelia burgdorferi has many hosts. For the record, we use a “tongue in cheek” byword when referring to treponema pallidum, which we refer to as “Lyme’s DUMB Cousin.”

We use this droll term based on comparative genomic profiling among spirochetal and other bacterial species, which makes Borrelia burgdorferi the clear winner in the microbial genetic lottery.

o) The authors compare the duration of treatment for Lyme disease to that of tuberculosis, another predominantly intracellular infection. We are amused at the implications by the authors that tuberculosis is treated successfully for a relatively limited period of 6 months, compared to LBC which “may go on for years”.

However, in the not so distant past, tuberculosis used to require 18 months or more of antibiotics. When better drugs became available and pulsed antimicrobial programs were employed, therapy was made more efficient and shorter in duration.

Of interest, pulsed therapy is precisely the treatment methodology employed by the Jemsek Specialty Clinic and other Lyme-literate physicians in treating “chronic Lyme disease”. Furthermore, as experience is gained, treatment programs using combination antimicrobials, as is the case for tuberculosis and HIV/AIDS among many other complex infections, is also allowing for more efficient therapy of shorter duration in LBC.

p) In terms of persistence, dozens ofarticles support this notion, including some of the authors’ earlier works. From a purely observational basis, if Borrelia burgdorferi is so easily dealt with in the infectious state, why does it proliferatively persist in hard-shelled ticks, various small and large mammals, and humans (not the end host). Why is it revered by microbiologists as the most uniquely and lavishly genetically-endowed bacterium on the planet, and why is it being so heavily patented by Universities, researchers and others, including the majority of the members of the committee who performed the NEJM review?

q) Approaching the stratosphere of arrogance, the committee goes on to summarize Lyme disease into 4 convenient categories, like shoeboxes lined up in a row for shoeless and illiterate providers, without vote or consensus via any authorized committee or organization which would consummately arrive at these “categories”; and yet these were blithely published by the NEJM. So, because they must be addressed, we will do so.

i. They do not accurately encompass the majority of Lyme disease patients.

ii. They choose to ignore patients who present to their physicians with clear erythema migrans rashes and other clinical symptoms of Lyme disease, but who are told they “do not have Lyme”, because the physicians do not recognize its clinical manifestations, or are relying on surveillance criteria definitions, and inaccurate laboratory testing.

iii. These individuals are then not treated, and go on to develop Lyme disease in a chronic form.iv. They also do not address patients who are misdiagnosed with other illnesses such as MS, ALS, RA and CFS.

v. The committee assumes at all points that patients are treated appropriately for their illness, and yet in fact, most patients receive little or no treatment, which is why they remain chronic.vi. In patients with positive serology and no objective symptoms, the Bb-associated illness may be subclinical, as research proves that Bb remains dormant within the body for extended periods of time, from months to years after infection. Some of the committee members’ own research clearly states this.

vii. Category 4 disease, as newly crafted and defined by the Lyme Cabal, has had an embarrassingly small number of treatment trials upon which to draw these conclusions. Further, in eschewing the study and expansion of the scientific and clinical horizons for the innumerable issues which remain to be addressed in this illness complex, the authors make it clear that they are content to remain entrenched in their existing dogma perhaps until it is “time to announce the Lyme epidemic” and bring out the new tests and vaccines.

The most prominent of the studies mentioned above was performed by Dr. Mark Klempner, a committee member who also happens to be on the editorial board of the New England Journal of Medicine. If the NEJM is an objective medical journal, we ask why this fact was not made prominently apparent for its readership.

r) The committee is disdainful about antibiotic therapy causing “considerable harm” to patients, but fails to mention that all medical treatments have inherent risks. This allowance by the editor of the NEJM is in and of itself, unpardonable. Further, the authors fail to present a balanced representation of the patient populations in question.

They fail for example, to mention that untreated and dismissed chronic Lyme patients commit suicide at alarming rates due to the hopelessness and agony associated with this illness.

s) The committee members claim those running clinical studies have had “difficulty” securing patients who meet the criteria of their obviously biased studies – such as the elimination of 500 people who were excluded because they lacked a “substantiated history of Lyme disease.”

Substantiated by what account? Most Lyme patients have no substantiated history of Lyme disease because doctors are missing the diagnosis and failing to treat these patients…more circular logic. Again, the committee is myopic in arriving at its conclusions about the scarcity of patients, either those “well-documented” or who develop “clinically significant problems” after “conventional treatment.”

We would like to provide the benefit of the doubt to the Lyme Cabal and pray that their glossing over and misinterpreting/ignoring or trivializing consistent and debilitating patient issues are not intentional.

t) There are untold thousands of individuals in our country and around the world who live unfulfilled and tortuous lives due to the political situation surrounding LBC and consequent access to quality care issues. A symptom of the rudimentary state in which we find ourselves is made evident by the authors suggesting that eligibility criteria for controlled trials require symptoms be “severe enough to interfere with the patient’s ability to function”.

This line of reasoning is simply astounding in its unsophistication and insensitivity. The committee’s statements about controlled trials and documented disease history is admirable and would be more so if the medical community was fully engaged in an environment in which, as in HIV research, the best minds were involved and funded in the pursuit of the study of this illness complex.

Patients know what has made them better and it is highly insulting to patients who are denied care or who had irreversible adverse health consequences to themselves or their loved ones because of suspect motivations by those who now hold power…….almost certainly the patient’s interest is not the primary concern in this story.

IN SUMMARY

Open attempts to intimidate the Connecticut Attorney General, physicians, and patients are not lending credibility to those who are perpetrating this behavior.

Nevertheless, the politicization of an illness for which many people are tragically suffering, and who are afforded very little credence by the scientific community when evidence shows their illness is real, and who are subjected to increasingly narrow treatment options, may indeed be approaching not only anti-trust violations, but scientific fraud on a grand scale.

The public confusion comes not just from the myriad of symptoms or the restrictive definition of the illness itself, but also from physicians and patients who are well aware of the illness within their own bodies, and who are confounded by the unwillingness of the scientific community to embrace a medical illness of such major significance.

Rather, many perceive an increasing plaintive and obvious disregard for the welfare of thousands of patients by a small number of individuals entrenched in power and trapped within their logic loops, whether these loops are genuinely believed, or contrived. Inaction is somehow justified on the basis of a lack of double-blind, randomized studies.

Regrettably, there also appears to be a barrier to publication of dissenting views by the editors and reviewers of established journals. The public, including some physicians, do know how to read, after all, and patents and a pattern of interpretative reversal in research opinions speak volumes about the truth of LBC.

So does successful resolution of symptoms through open-ended, long-term antibiotic treatment of Lyme disease. In this complex illness, therapy is most often successful, i.e. life restoring, when it is patterned on an increasingly sophisticated understanding of the many interwoven issues involved in the illness, and in the successful integration of therapies which address the immunosuppressive, multi-systemic, polymicrobial disease complex which is LBC.

Most of us deeply involved in patient care don’t care who takes credit for change, and realize that traditional powers must engage for this to happen. We encourage this at every opportunity.

Physicians and patients are earnestly waiting for the truth to be revealed, and we hope that this truth will arise from the medical community in a proactive and vigorously engaged manner. LBC is just part of what is driving an epidemic of unwellness and chronic illness in this country.

The paradigm of medicine and chronic illness must change over time………too many of us are sick and getting sicker.

Okay first of all how does anyone even know this blogger is a doctor? Second of all how seriously can you take a man who puts three questions marks at the end of his sentence. Third how seriously can you take a man whose favorite website is Quackwatch.

Why did you become a doctor? for the money? Because I find it very hard to believe that you actually care for you're patients if you write things like this...People have died from the disease, how unrespectful can you get?There is plently of scientific papers out there proving that Lyme disease can PERSIST despite the standard antibiotic treatment, you just need to OPEN YOU'RE EYES AND YOU'RE MIND. It's only the open-minded doctors with clinical experience of treatment hundreds or thousands of Lyme patients, or the doctors that have suffered from this disease themselfs that understand what it is like.I am sure one day all of this will be settled and everyone will remember the ducks at IDSA, and doctors like yourself who were saying stuff like that. Nobody believed in late-stage Syphilis either, but look what that can do.Why don't you go and research the actual bacteria, it is so damn clever that it can evade our immune systems and antibiotics by entering into our own cells, changing forms, etc. This is all in scienfitic journals, you just need to look for them...

It's easy to spot a bad doctor, were you not taught in med school to listen to the patient? The patient is the most important source of infomation, not ridiculously poor blood tests that most doctors completely rely on.

Do you honestly think we want to be ill? or do you just not believe us, or what? I have personally lost everything, my money, friends, family, job, my whole life and trust me, it isn't nice.

Hi. There certainly is a holy war about lyme. Do a little homework and you'll find there was once a holy war about syphilis...for fifty years, late stage (tertiary) syphilis with dementia/madness was called para-syphilis, and supposedly not due to the microbe, which had long gone. Probably the real reason driving this was the fear that madness could be contagious (through a spirochete). After penicillin, syphilis became syphilis.

There is enough evidence that some infections become chronic, or relapsing/remitting and require long term open-ended antibiotic therapy. For instance, the acute form of Q Fever can be treated in 10-14 days of antibiotics but the chronic form requires years. Why should borrelia necessarily be different?

In addition, recent work by Eva Sapi PhD found many infectious organisms in ticks, and these organisms also cause acute and chronic illness. In several hundred ticks gathered in Connecticut, she found mycoplasmas, babesia, erlichia, bartonella, along with borrelia. A majority of ticks were coinfected. This is probably due to the natural spread of the organisms and the illness.

Thus chronic lyme may not simply be an acute infection with one strain of borrelia. It may be the collapse of the immune system after repeated tickbites in endemic areas, misdiagnosed, with multiple chronic infections.

So you should just do your research better. Also there are very convincing animal studies showing persistent infection of borrelia even with immediate treatment with 30 days of doxycycline or amoxicillin after inoculation with the organism.

It would be better if you spent some time perusing the actual literature.

I don't believe you're an MD. Lord knows there are some terrible MD's out there, but to me it sounds like you're some ignorant, sad person that feels the need to make himself feel more important than he really is by saying he's an MD. Most MD's don't have the time to sit around talking down on sick people on a BLOG.

Oh, and I'm not rich. I'm newly married and my husband and I are barely getting by each month. I can't even make it to work any more. I have to work at home because of this illness. You have NO right to talk such crap.

I'd say I hope you, at some point, get lyme disease, but I wouldn't wish lyme disease on my worst enemy. It's THAT bad. How dare you act like you know what you're talking about. You will NEVER know what it's like until you get as sick as we do and consequently have to live the life of being scared and afraid because MD's (like you're pretending to be) treat us less than human and dismiss us. There are people who die because of this.

In the hypocratic oath, all doctors take an oath that they will do no harm or bring no injustice on the sick. If you really are a doctor, you're really holding up that oath, aren't you?

Perpahs it is time you stopped being such an angry and apparently arrogant doctor and more of a compassionate and eager to learn one instead. Try it.

Before you criticize the Attorney General too, you might want to look into this a little deeper and then you may not be kicking yourself later for making yourself sound an idiot for defending criminals.

The time will come, pretty soon probably, when you're going to wish you never wrote this particular blog on Lyme disease because you will see just how dumb you sound once everything becomes self evident.

No evidence of chronic lyme? Wha???? Actually, there are thousands of studies -- peer reviewed, published studies!! By such prestigious institutions as Valhalla, yet! Many done by IDSA authors themselves!! But in choosing carefully which studies to pick for their "Guidelines," IDSA authors culled carefully, selecting a few hundred (mostly their own) from the thousands in PubMed.

All studies demonstrating bacterial persistence are explained away as being obviously due to "errors in the lab."

Try reading Brian Fallon's newest study. It was double blinded and so rigidly controlled as to be unassailable -- unlike Klempner's previous "studies."

Try and educate yourself before spouting off so you at least sound like you know what you're talking about. Otherwise, you are embarrassing yourself by repeating the tired dogma of others.

OK, I read your whole blog, to try to get to know whoyou really are. You seem like a young doctor, beenpracticing about 5 years, so you certainly are not rich. You are still in a lot of debt from your student loans. From most of your other posts you seem like a person who stands up for what you believe. You hate the state of medical care in this country, with the insurance companies screwing everything up, the way the ER handles things, the miscommunication between specialists and GP's. I agree with almost all of your other blogs. The one about disability.....I don't know. I am sure there are a lot of fakers out there, but as someone who has worked all my life with severe disabling symptoms, I believe there are just a lot of diseases out there that just haven't been discovered yet. And there are a lot of people out there with real physical diseases that are misdiagnosed as mental illness and covered up with psychiatric medications. As far as quackwatch goes...I hate to say I do agree with some of their ideas. There are a few supplements and alternative therapies that really do work, and have been proven so in double blind studies. But then there are a lot of quacks out there trying to make money off deperately sick people. I was one of the desperately sick people conned into spending thousands of dollars on "alternative therapies" If I hadn't been taking hundred's of dollars a month of vitamins and suplements for the past ten years, maybe my lyme disease would have been discovered sooner. Anyway, you seem like doctor who makes his own decisions. You hate big pharma. You do not seem like a sheep. So whats up? How can you be so dead wrong about lyme disease? Maybe you have not actually read the studies on lyme disease; maybe you are just listening to the opinion of the board members and guidelines of the IDSA? If thats the case, you need to start reading. You seem like you would be a good doctor to have on our side. Look at the studies done from the 80's up until now. I am going to give you the benefit of the doubt and just assume you are a good guy who has been misled and just blindly trusted the wrong people. Those same IDSA board members proved many years ago that lyme disease does persist after treatment with many months of antibiotics. They proved that it is diabling, gets into the brain, causes permanent damage, etc. Those earlier studies are out there, they are published. Then out of the blue they just changed their minds and said it was not a problem when the vaccine was being developped. Then when the vaccine came out, they said it was a dangerous disease again, because they held patents on the vaccine. They said in earlier studies that the tests were inaccurate. Then when they bought the patents on the tests they said the tests are accurate. There were no new studies done that should cause them to change thier minds all these times. When people started to question them, they did a few studies that were blatantly staged and fixed to "prove" their 20 years of previous research wrong? something stinks to high heaven. Here is an example of how low they will stoop. Look at the new Fallon study. He has people who test positive for antibodies for lyme and have disabling symptoms. Fallon proved that after 10 weeks of IV antibiotics, their symptoms were much improved. There was no improvement in the group that received the placebo. Then they stopped antibiotic after 10 weeks and were tested again at 24 weeks and most of them relapsed in their neurological symptoms, although their pain and flu-like symptoms did not return. To me, this shows that the antibiotic did work, it controlled their symptoms, but it did not completely eradicate the disease. So one would conclude they need even more than 10 weeks. Whatever the cause, the study proves that antibiotic relieves symptoms, and that it is not a placebo effect. The level of disability warrants open-ended treatment of lyme with antibiotic. As far as the "dangers of antibiotic" that decision should be up to the patient, just like steroids and chemo are offered even though they are dangerous. But the IDSA doctors took that same study, and reported the following story: patients were given 10 weeks of antibiotic, tested 24 weeks later, and showed no improvement in cognitive function, and therefore antibiotics are not warranted. This is not technically a lie, but it is not the whole truth. they failed to comment about the FACT that after ten weeks, there was dramatic improvement. Thay failed to report that the study showed that other symptoms, such as pain, numbness, tingling, twitching DID show huge improvement after 24 weeks. So the IDSA doctors picked out what they wanted from the study to support THEIR opinion and ignored the facts. That is totally unacceptable. Are these the doctors you want to support?If you really are a doctor, explain these questions I have, because I have never gotten a doctor to answer these questions:I had fever, sweats and joint/muscle pain that responds dramatically to antibiotic, i.e. symptoms resolve after 24-48 hours on antibiotic and return after 1-2 weeks of stopping the antibiotic. I also have swelling, twitching, history of bullseye rash, tested positive for exposure to co-infections, heart valve damage, meningitis, cranial nerve palsy, and every single other symptom of lyme disease, all of these confirmed by neurologists and other specialists. Would you conclude this is a chronic infection? Is it possible that this is drug fever, or is drug fever the opposite, i.e. the person gets worse with antibiotic and gets better when going off. If the antibiotics were causing an anti-inflammatory effect, wouldn't steroids work better? Steroids cause the fever to spike and worsening of the condition, doesn’t that indicate infection? Also, how can a person still test positive for antibodies if they do not have a current infection? (the IGM is positive and IGG high, it is close to the cut-off for being positive). I understand in many viruses, such as chicken pox, people test positive for life and are therefore immune. But with lyme, they can be reinfected. So if a person has an equivocal test, doesn't that mean they still have some antibodies and therefore still have an infection? Isn't it either presence of antibodies meaning positive, or no antibodies meaning negative? Can you have "a little bit" of a bacterial infection, or you either have it or you don't? If they can still produce antibodies after 25 years, how would you be able to tell if someone is re-infected? Lastly, with most infections (respiratory, cellulitis, etc) patients are treated based on symptoms and response to antibiotic, i.e. if they do not improve on antibiotic, it is assumed that they have a virus. Doctors don't test the blood for localized infections, as it is not in the blood unless they become septic. If someone has symptoms of sinus infection for example, they are nto blood-tested. Why is lyme treated differently? Anyway, I hope you read this blog, and I hope you read into lyme disease further. Look at the studies and make your own decisions. I was in denial for ten years, even though I was suffering, because I believed the doctors. Now I am on antibiotic and better. After reading the evidence myself, I made my own decision. But lately, these past few months, the unethical behavior of the IDSA doctors has really convinced me more than anything else. They are really grasping at straws now, obstructing justice; they are burying themselves and will probably be locked up soon.

one thing this thread clearly demonstrates: there is BIG MONEY to be had in validating peoples' false belief that they suffer from chronic lyme disease. If I just gave up real medicine for a month, pretended i agree with this sh!+, and pandered to posters like these, I'd actually be able to get RICH, unlike doing real medicine for the good of your patients.

Oh, and in ripping people off, I'd actually be NOT pissing them off - ironic, isn't it?

I'm not saying these folks aren't suffering from SOMETHING. But if the science (from actual scientists, not a lawyer & some malingerers) isn't there, it flies in the face of the scientific method to assume it is & prove otherwise.

Wow. Were are these people coming from! Like a poster said earlier, you must have been linked at the "chronic lyme disease is a real disease and I will make not so subtle threats if you say otherwise.com" site.

Judging from the comments posted, most by anonymous, it is clear to me that the chronic Lyme disease crowd is more likely suffering from severe depression and other forms of mental illness. The volume of comments and obsession with being sick is truly pathetic. In California, the Lyme crowd serves public health agencies with endless public records requests including their work emails to badger and intimidate anyone who dares question the religion of Lyme disease. They show up at meetings and conferences and shout down people who try to present evidence that is counter to their obsession. They flood blogs and any other forms with comments and feedback that overwhelms the debate. My only question to them is, After Chronic Lymes is finally disproved what disease will you move onto next? Fibromylagia, Chronic Fatigue, Epstein Bar, Toxic Mold, Chemical Sensitivity syndromes, - Oh, I forgot, most Chronic Lymes people have experienced these. Guess they will have to invent something new.

I am a layman lurker here, but came across an article some time ago about the fact that there are 10x as many bacteria in the human body as human cells. Most of which are good for you, and we really know little about what the impact they have on the human body. You won't die without them, but are not nearly as healthy without them.

So, a hypothesis. Some one gets Lyme disease goes through many weeks of antibiotic treatment killing the Lyme disease bacteria and who knows what other normal flora and fauna. Antibiotics stop and now there is an empty bacterial niche in the body. Ideally, the same bacteria would return and all would be well, but maybe they don't come back or the proportions are wrong or whatever.

So, then why would more multiple antibiotic treatment help? My thought would be it is a reboot of sorts, change antibiotics different bacteria die and different new ones take their place eventually maybe the right ones dies or the right ones develop resistance and things return to normal.

Given another recent article about the purpose of the appendix it would be interesting if there were strong correlation between chronic lyme disease and a removed appendix.

Dear Doctor(???)Who are you? Please give me your name and address and I will make an appointment with you. Can you PROVE that I do NOT have chronic lyme disease? I really wish you could. If it is not lyme disease then what is it that I am suffering from? I am sure you are smart enough to figure it out as you seem to have all the answers. You ask for proof of chronic lyme disease, ok, I ask you then, Show me PROOF that I don't have it.

Pompous and totally ignorant to the suffering of others, and a disgrace to your profession.

Especially the comment about the AG of Connecticut. He isn't a doctor, you are right but he knows when something smells fishy and people are getting hurt.

There are two camps and you sir are stuck in the middle ages as far as your opinion is concerned regarding Lyme. Newer studies, and the Columbia Lyme Desease Research Center support the findings of other more caring, tenacious doctors who take their patients at their word and look for answers.

Obviously, you are to angry (why?) to do any research on your own so you just believe everything you read.

By the way. I had a punch biopsy, positive WB, and I was pregnant at the time also. My son was born in distress, and has been suffering for ten years now. He has had bouts that have adversely affected his vision, two operations to save his hearing and numerous other ailments. My disease was diagnosed by a dermatologist, and then my obgyn put me in contact with the Infectious Diseases Chief of Staff at a major NY teaching hospital.

I pity you. You live in New York you had better stay away from Greene County because if you ever go their and get bit you might have to do some fancy dancing to get treatment yourself.

I was insulted by the whole thing, but dumbfounded that you believe the AG just woke up one day with no evidence whatsoever and decided to take on the most controversial of medical topics just because...

I think that the main point here is that you really do need to listen to the paitent(s) before any diagnosis is rendered.

And why wouldn't they have Lyme Disease, No other doctor in our case has come up with a better explanation for what is going on - No misdiagnosis here - just - "We don't know what you have and then when I requested another Lyme test, WOW, 3 1/2 years later, It's positive.

So the many symptoms that came with this disease were....What, a figment of imagination. I highly doubt that beings there was finally a positive test.

If you are so adament on it not being Lyme - then get off your butt and do some research yourself, come and visit us and see what is going on with our treatment.

The Crock of Lyme Disease is that many doctors like yourself(if in fact you are) don't give a rip about the patient - I am not sure what you care about - Money? Prestige? It sure is hell isn't the Patient!

I will post my questions again. I guess there are no real doctor's here who can medically explain answers to these questions. But giving the benefit of the doubt, maybe they just did not see the questions:

I had fever, sweats and joint/muscle pain that responds dramatically to antibiotic, i.e. symptoms resolve after 24-48 hours on antibiotic and return after 1-2 weeks of stopping the antibiotic. I also have swelling, twitching, history of bullseye rash, tested positive for exposure to co-infections, heart valve damage, meningitis, cranial nerve palsy, and every single other symptom of lyme disease, all of these confirmed by neurologists and other specialists. I was told it could be "drug fever' Isn't drug fever the opposite, i.e. the person gets worse with antibiotic and gets better when going off? Another explanation was the antibiotics were causing an anti-inflammatory effect. If that were true, wouldn't steroids work better? Steroids cause the fever to spike and worsening of the condition, doesn’t that indicate infection? Also, how can a person still test positive for antibodies if they do not have a current infection? (the IGM is positive and IGG high, it is close to the cut-off for being positive). I understand in many viruses, such as chicken pox, people test positive for life and are therefore immune. But with lyme, they can be reinfected. So if a person has an equivocal test, doesn't that mean they still have some antibodies and therefore still have an infection? Isn't it either presence of antibodies meaning positive, or no antibodies meaning negative? Can you have "a little bit" of a bacterial infection, or you either have it or you don't? If someone can still produce antibodies after 25 years, how would you be able to tell if someone is re-infected? Lastly, with most infections (respiratory, cellulitis, etc) patients are treated based on symptoms and response to antibiotic, i.e. if they do not improve on antibiotic, it is assumed that they have a virus. Doctors don't test the blood for localized infections, as it is not in the blood unless they become septic. If someone has symptoms of sinus infection for example, they are not blood-tested. they are treated based on symptoms, i.e., pain in cheeks/forehead, fever, nasal congection. Why is lyme treated by blood test when the CDC clearly states at the bottomm of the test results that the test are only for surveillance purposes and not to be used as diagnostic in the case of a high degree of suspicion.

If no one can answer these questions, then I assume you are either not real doctors, or that you have no explanation and just say "there is no chronic lyme because I said so" and have no scientific explanation for these significant relevant questions.

Seems like some people might be confused about this... I'd just like to say that a history of tick-bites, bull's eye ring, and related condition isn't really a "chronic" infection. Isn't it more like... repeated infections?

Personally I hate flying. It makes me nervous and upset my stomach for quite a few days. If I have to travel by air each week for the next 6 months, I'll have upset stomach all the time. But my problem is not persistent upset stomach that just doesn't get better, my problem is caused by my trips each week in those 6 months.

This is just propaganda on the internet to counteract all the people coming to the being informed of tick borne infections that do and can cause chronic problems that have been clearly documented in the past 20 years.

If we are to make assumptions like about the poloticians we might as well make assumptions about the posts of anonymous people with names posing as nurses to give very similar attitude of the poster him self..

We might as well make assumptions since no science is going on here other than people on two sides calling each other names..

There are some educated people making claims and comments here but no educated answers from the other side just the same age old spin of accusations and name calling..

It sort of reminds me of grade school.

Good job Doc.. You really show your rookie colors.

Get educated or get out of the way but this type of blogging does not do anything against the masses. Even the Media cannot properly spin the IDSA's goals because so much opposition exists in support of ILADS..

If a patient is not diagnosed, they are not then treated; Is that safe to assume?

This population is developing Rheumatoid and Neurological symptoms and have Postive Western Blots... What would YOU suspect is their problem?

Until 20 years ago HIV "did not exist" at least according to you and/or geniuses like you. Even now you would consider AIDS a non-problem. ONLY 40,000 cases of AIDS last year vs 200,000 cases of Lyme, per CDC.

10 years X's 180,000 UNDIAGNOSED Lyme cases = 1. 8 million! Throw in another 10 years.. and consider that CT does not even report Lyme now... and many providers and/or patients won't allow a DX of Lyme on their medical records.... we could easily get a number like 3 million (!) UNDIAGNOSED LYME cases. Do you consider 1% of the U.S. population RARE?

I have read the article in the New England Journal and examined the studies carefully, I agree dear doctor that chronic Lyme disease does not exist after treatment and those patients who do suffer post Lyme symptoms have other underlying problems. Many times the patients may have an underlying anxiety, depression, fibromyalgia, or chronic fatigue syndrome which they attribute to the spirochete infection. Studies show that even healthy patients exhibit fatigue like symptoms from one time or another. This does not mean that I have no empathy for patients presenting with such symptoms. On the contrary I am eager to help them get better with a more evidence based diagnosis!! Great article!

Wow....the many responses here certainly verify just how loony the Chronic Lyme people are. Sucker born every minute, you say? Far more than that! Great blog, great links, thanks for some clear thinking!

those of you in the "medical proffesion" calling those who suffer looney wack jobs only prove the stereotype that many of you are uncompassionate jerks. trust me, if you or your family member got LD you would feel very differently. We are beginning to turn the tide-the IDSA is under investigation for fraud and being in the pocket of the insurance companies, and I wouldn't be surprised if this "doctor" isn't either, if he even is one. We will fight to be heard and we will NOT go away, and you can call us all the names you want, we are a thorn that will keep getting bigger and louder no matter what you do. I wish you could know what it's like for even a day. btw, I'm someone who was helped by Lyme treatment, the my evidence is my own body. and I've seen many cases like mine. there are many many scientific studies that have been held back, and if you bothered to do any research, you'd know that. doc, if someone you cared about developed such symptoms, would you call them a sucker? and why is it that docs like you will prescribe antibiotics for 2 years for tuberculosis but not for Lyme? ONLY the IDSA says what you say. MANY other sources say otherwise, but you don't bother to research. As for the nurses on here, I'm glad you said who you are, now I know to avoid you. the only wack jobs are you-you obviously don't care about people and you have blood on your hands b/c you are actively encouraging the myth that is killing us. I hope one day you realize the error of your ways. Whether you do or not, you WILL NOT silence us.

Jerk Alert! Do not give this goof the time of day. It just goes to show that today ANYONE can get a degree in medicine. No wonder there are so many screw ups and that the malpractice insurance is so high! There is always someone that graduates last in the class--I'd bet my money that this doctor wannabe was just that guy. Lyme sufferers, I know your pain, but suck it up and wait patiently for your rescue. Don't whine to the haters out there. They will only belittle you. They will get their thing too some day. Even doctors get sick. People who have no compassion for others, usually get a dose of something bad to bring them to their knees. The Angry Doctor? Ridiculous! You can't make a person with this type of attitude be understanding or compassionate. It is scary to think that this type of person would really be a doctor. He needs some anger management maybe. Let's get this "self important" Mike guy back on his train to nowhere! Or back to his TV. He's not spouting off since October '07 though. Maybe he's been busy with a malpractice suit or crying to his doctor about a health issue. Hope so.

If not chronic Lyme then what the fuck do I have???? I had Lyme disease and I was treated using conventional antibiotic approach and continued to worsen.

If I don't have a Lyme infection, fine, figure out what I have you piece of shit. Fifty percent of patients treated develop further symptoms. What do we do about them?? Throw them in the garbage???? You don't understand our illnesses therefore our illnesses don't exist??

Remember there was a time when they considered MS to be a psychiatric illness.

There was a time when HIV/AIDS was not considered to be a public health concern.

You are an absolute idiot! G-d forbid you or a loved one (especially a child) should ever be misdiagnosed only to find out many months or years later that it is Lyme. G-d forbid some schmuck like yourself tells you that it is all in your head and treats you with everything else but the antibiotics that you needed in the first place. If that were to happen and you did not get treated, you will get very sick and 4-6 weeks of antibiotics at that point will not work. Trust me, after 6 weeks, I was not feeling better. I took about six months worth of antibiotics plus other meds and I am significantly better. Wow that is shocking, huh? I am not 100% better but at least I have my life back. Screw the studies!! How many people suffering with Lyme will be evidence enough for doctors...or should I say the insurance companies who don't want to pony up and help treat us. If you are fortunate enough to make it through life without any debilitating disease, don't worry you will get yours in the end when your are burning in hell your load of crap and for the countless number of patients you probably misdiagnosed and mistreated!

MEDICAL SCHOOLS ARE SIMPLY GLORIFIED TRADE SCHOOLS THAT UNFORTUNATELY SPEW OUT THIS FUNDAMENTALLY BRAIN DEAD SUBHUMAN LIFE FORM.....WHO IS SUPPOSE TO INTERACT IN A VIABLE, HOPEFULLY INTELLIGENT WAY.

AS A NARCISSIST YOU DON'T STAND A CHANCE... ONE, YOU ARE INCAPABLE OF ACTUALLY FEELING OR BEING EMPATHETIC...LET ALONE SYMPATHETIC.

ITS UNFORTUNATE BUT, MOST PHYSICIANS ARE LIKE THIS TRITE IMBECILE....YES, YOU ARE ANGRY...ANGRY BECAUSE YOU DO NOT HAVE THE DEPTH AND CREATIVITY IN YOUR PEA BRAIN TO CONSIDER ANYTHING BEYOND WHAT YOU LEARNED AT SCHOOL. YOU SIMPLY KNOW WHAT YOU KNOW....HOW PATHETIC! BECAUSE MOST OF YOU(ANGRY DOCTORS) OUT THERE DO NOT HAVE THE GUTS TO ADMIT THAT YOU KNOW NOTHING... THAT YOU ARE IDIOTS AND THAT YOU LACK THE SOCIAL SKILLS WARRANTED TO BE A GREAT DOCTOR. A DOCTOR THAT SEES THE WHOLE PATIENT...THAT RECOGNIZES THAT YOU ARE NOT GOD....AND THAT YOUR NEGATIVE WORDS ARE SO CONDESCENDING MAY HURT A PATIENT.

YES, YOU ARE ANGRY...ANGRY BECAUSE YOU ARE LESS THAN WHAT YOU COULD BE..AND FOR THAT MANY OF YOUR PATIENTS ARE PAYING A HEFTY PRICE FOR BEING IN YOUR CARE.

HOW SAD! DO EVERYONE A FAVOR AND GO TO REMOTE ISLAND AND SEE IF YOU CAN TOLERATE YOUR OWN COMPANY!

MORONS LIKE YOU ARE ABUNDANT...GREAT MINDS ARE RARE.

CHRONIC LYME DISEAE IS REAL...IT PRESENTS ITSELF IN MANY WAYS.I DO NOT WISH THIS DISEASE ON MY WORST ENEMY. IT IS A DEBILATATING, HORRIBLE DISEASE THAT LEAVES ONE AT THE POINT OF HYSTERIA, DEPRESSION AND YES, THERE ARE DAYS THAT YOU WISH YOU WERE DEAD...FOR IT IS SO PAINFUL.BUT, YOU WOULD NOT UNDERSTAND THIS BECAUSE IDIOTS LIKE YOU DO NOT HAVE THE COGNITIVE SKILLS CAPABLE OF UNDERSTANDING ANYTHING THAT IS A LITTLE BIT GREY...

YOU BELONG IN A LAB WHERE AN AMOEBA HAS MORE PERSONALITY THAN YOU... YOU SHOULD BE RUN OUT OF TOWN.YOU ARE WHAT GIVES REAL INTELLIGENT DOCTORS WHO ARE IN THIS PROFESSION A BAD NAME.

YOU ARE A QUACK...AND THIS CROCK OF BEING A DOCTOR..WELL, DO US ALL A FAVOR...

MORONIC THOUGHTS BY A NARCISSIST SO-CALLED DOCTOR...FUNNY THAT YOU SHOULD BE SO ANGRY...I WOULD THINK THAT YOU WOULD BE CAPABLE OF ANY EMOTION MUCH LESS ANGER...BUT, I FORGOT WHO WE ARE DEALING WITH.

ANGER IS EQUATED WITH SOMEONE THAT DOESN'T HAVE THE CAPACITY TO INTELLIGENTLY ABSORB ANYTHING RATIONALLY...AND HAVE A SENSE OF HUMOUR ABOUT THE SUBJECT OR THEMSELVES FOR THAT MATTER INSTEAD GETS ANGRY...AS IF IT IS A POWERFUL ATTRIBUTE. HOW WEAK AND HOW PATHETIC.

BE ALTRUISTIC! HELP SOMEONE AND SAVE YOURSELF FROM YOUR "ANGER" dummy!

The long latent stage seen in syphilis, followed by chronic central nervous system infection and inflammation, can be explained by the persistence of atypical cystic and granular forms of Treponema pallidum. We investigated whether a similar situation may occur in Lyme neuroborreliosis.

Method

Atypical forms of Borrelia burgdorferi spirochetes were induced exposing cultures of Borrelia burgdorferi (strains B31 and ADB1) to such unfavorable conditions as osmotic and heat shock, and exposure to the binding agents Thioflavin S and Congo red.

We also analyzed whether these forms may be induced in vitro, following infection of primary chicken and rat neurons, as well as rat and human astrocytes.

We further analyzed whether atypical forms similar to those induced in vitro may also occur in vivo, in brains of three patients with Lyme neuroborreliosis.

We used immunohistochemical methods to detect evidence of neuroinflammation in the form of reactive microglia and astrocytes.

Results

Under these conditions we observed atypical cystic, rolled and granular forms of these spirochetes.

We characterized these abnormal forms by histochemical, immunohistochemical, dark field and atomic force microscopy (AFM) methods.

The atypical and cystic forms found in the brains of three patients with neuropathologically confirmed Lyme neuroborreliosis were identical to those induced in vitro.

We also observed nuclear fragmentation of the infected astrocytes using the TUNEL method.

The results indicate that atypical extra- and intracellular pleomorphic and cystic forms of Borrelia burgdorferi and local neuroinflammation occur in the brain in chronic Lyme neuroborreliosis.

The persistence of these more resistant spirochete forms, and their intracellular location in neurons and glial cells, may explain the long latent stage and persistence of Borrelia infection.

The results also suggest that Borrelia burgdorferi may induce cellular dysfunction and apoptosis.

The detection and recognition of atypical, cystic and granular forms in infected tissues is essential for the diagnosis and the treatment as they can occur in the absence of the typical spiral Borrelia form.

Since many symptoms of chronic lyme disease are similar to chronic fatigue syndrome, I suggest reading the following research: Laylander, J.A., (1999). A Nutrient/Toxin Interaction Theory of the Etiology and Pathogenesis of Chronic Pain-Fatigue Syndrome: Part I and Part II. Journal of Chronic Fatigue Syndrome, Vol. 5(1) 1999.

http://www.earthclinic.com/laylander-1999a.pdf

http://www.earthclinic.com/laylander-1999b.pdf

Laylander’s research review is convincing that chronic fatigue syndrome is caused by Magnesium Deficiency and concomitant Fluoride Excess (MDFE).If so the cure is to quit all fluoride intake, including fluoridated water, soda pop, any beverage made or reconstituted with fluoridated water; and to take a magnesium supplement. The best magnesium supplement is magnesium citrate, found in the laxative section of pharmacy or Walmart. Take about one ounce a day; keep refrigerated after opening.

Why don't you and your con artist doctor friends tell the people about the accuracy of your tests. Example being the ALISA test, it's 40% accurate and you can get 50% by tossing a coin.

Tell them how you dispense antibiotics when needed. It's a "WELL THIS SHOULD WORK" kind of a procress. I doubt if you even know what a MIC test is or even used one!

Why not tell them about the chemicals in the vaccines that you and your band of thieves are pushing. Maybe you could reveal how damaging the effects of the steroids are that you are pushing on unsuspecting people and how useless they really are.

SO how many Lyme patients have you cured or even seen? I'm sure glad your not my doctor and you better hope that they don't go after mine because of your moronic comments!! I've lived 20 years now because of antibiotics provided by my doctor and I owe him my life.

BET YOU WON'T GET ONE PATIENT TO SAY THAT ABOUT YOU!!

It's idiots like you that kill people, like my dead friends. They died of heart attacks brought on by Lyme Disease! (cardiomyopthy)

Let's hope neither you or any of your family members contract Lyme disease.

How about you go see the documentary, "Under our skin." http://www.snagfilms.com/films/title/under_our_skin/ and let's see how funny you think lyme disease is then. Wake up because believe me ignorance is bliss.

As a physician I am inclined to disagree that patients are delusional and malingers, as suggested by previous responses.

What I do see are patients who are suffering, angry, abandoned, dying, and forced to find solutions that we, their medical providers, ought to be doing.

My practice was flourishing and successful prior to my own declining health. Occasionally I saw patients who suggested they may have Lyme Disease; I usually dismissed it, especially if objective indicators were absent and their initial test results were negative.

Today it is evident that I was unfortunately ignorant of the dangers of underestimating this illness. Even more disconcerting was a lack of empathy when the very idea of Lyme Disease was discussed with my own primary care physician. I did not see a rash, nor a tick when infected on Martha's Vineyard during a family vacation. Like many of my colleagues, I was certain when my tests came back negative that I simply did not have Lyme Disease. Fortunately, I was able through extensive investigation and high costs, to identify the infection through culture. This is simply not feasible for patients, as the cost can be astronomical. Hiring specialists, as well enduring the time and vigilance required to seek out Borrelia Burdgdorferi within tissue samples and confirm those findings via genetic sequencing is a tedious task..

I had 7 Western Blots at 5 different facilities, Mayo Clinic in Rochester, Minnesota, The University Of Pennsylvania, Quest Laboratories in Cambridge Massachusetts, Stony Brook University Medical Center in Stony Brook, New York , Igenex Laboratories in Palto Alto California and Massachusetts General Hospital in Boston. 4 PCR tests were performed and finally one lumbar puncture. These tests proved ineffective, including the specialty lab Igenex, which is often accused by some physicians as producing too many false positives. It took months, in order to confirm the diagnosis, and I had access to the best and brightest specialists.

It's been nearly 2 years since antibiotic therapy began and while I'm still improving, continued culture identifies the infection while antibody testing remains negative. My own peers and family were reluctant to tolerate my findings, even when objective evidence was provided.

It is terribly unfortunate that patients suffer at the expense of nonfunctional guidelines, and I find it even more disturbing that many physicians I previously associated with are just as apathetic and disdainful towards my own plight as that of the patients they see who profess their struggle with this disease.

The additional burden of Babesiosis infection, Rocky Mountain Spotted Fever, Tularemia, Human Monocytic/Granulocytic Ehrlichiosis is all the more perplexing, complicating the already complex landscape of tick born infectious disease presentation in patients.

If I did not see a rash and I did not see a tick, then you may ask how it is possible that I "assume" I was infected by a tick. That answer is quite simple. I was also infected with Babesiosis and Erlichiosis, both of which were not identified as a consequence of simply not testing for them initialy. The testing through three of the 5 laboratories was positive for Erlichiosis HGE. Babesia Microti was cultured at Stonybrook in New York. These findings reinforced the possibility that Lyme Disease was also involved.

An exhaustive review of the literature will lead different people to different conclusions, but what is quite clear is that there is abundant evidence available to avoid restrictive guidelines for the treatment of Lyme Disease. Too much remains unknown, and to effectively assist patients physicians must assume a flexible stance. It's important that medical providers evaluate each case carefully based on all available evidence whether subjective or not, and weigh the risks and benefits of exploring treatment options with the patients informed consent and active participation.

The other thing that cracks me up is their is no reliable test for just to name a few...CFS, MS, Fibromyaligia and no cure mind you...but those exists, but Chronic Lyme doesn't...Ya ok, and the earth isn't round either...

You are a clown! As a friend on Lymenet would say...Where did you get your medical license? In a cracker jack box? What a joke!

The biofilm has been discovered and published, end of story. There is nothing else to prove that havsn't already been proven. The science has spoken, you just have to listen.Chronic Lyme disease exists, it is not a figment of people's imagination.

Wow! You are a piece of work!How are you to judge something that you clearly know nothing about?You should get your facts straight before you start saying things that are not only false but are going to p*ss off a whole lot of sick people!!It's called "bio warfare"...do some research!!!

Jeez Doctor, Are you telling me two woman I know don't suffer from chronic lyme disease? I'm shocked. One is on disability at age 42. She pops pain pills and anti depressants all day long. She suffers from fibromyalgia too. She's so sick she gave her seven year old son to her former husband to take care of. Then there's my nephew's wife. She's so sick with undiagnosed lyme disease she lies in bed all day long. She also pops pain pills and anti depressants. The Cymbalta eases her fibromyalgia though. Thank goodness her husband makes a lot of money. This way she can travel out of state for special alternative treatment where they keep her at least able to go to the hair dresser and nail salon by placing crystals on her body. I just don't know what to think about your mean blog. ; ]

Careful, dear doctor, you just might end up with a dose of your own medicine. And then where will you be? Certainly not practicing medicine and decidedly not receiving treatment.

To prove the inaccuracy of your beliefs concerning Lyme Disease, I hereby offer you a pint of my own blood. I will gladly pay for any lab costs associated with said blood transfusion. I will even pay the travel costs associated with meeting you at your hospital.

One transfusion and then you will know me. One transfusion and then you will know all too well what hundreds of thousands of sufferers from this Lyme pandemic experience.

You will contract a toxic soup of bugs such as Borellia Burgdorferi, Babesiosis, Bartonellosis, Mycoplasmas.

Just let me know when the time is convenient and I will be there; I and all of the infectious diseases I now am carrying within my body.

ERMurse - first off, you stated "Chronic Lymes".... uh, it just goes to show you have no idea what you're talking about, you can't even say the damn disease correctly. Very bright one you are. Even worse that you're a doctor. An ER doctor at that. Pfft.

And oh no, I'm using anon again, must mean I have depression and a mental illness.

Yeah, we are so going to believe we have a disease like Fibro or CFS that doctors try ramming down our throats when there is no test for it. It's a catch-all diagnosis that doctors use when they don't know what is wrong with their patient. Instead of truthfully saying, I don't know what's wrong with you, they say whatever to get you out of their office and to save face.

WOW! The blogger who refuses to identify him/herself is obviously a coward otherwise he/she would sign their name to their opinions. Alright, if this person is really an ERNURSE than they are not a psychotherapist. This "ER NURSE" needs to keep his/her mouth, or her fingers rather, clasped shut.

The "doctors and physicians" writing on here too are disgusting. And if, patients who have CLD are mentally ill this would certainly not be a professional way to address them. You are simply hateful school yard bullies who hate the under-dog. Let me guess? You probaby hate people of a minor ethnicity, if you are men than maybe even women? HOW ABout Gay and Lesbians? Mentally handicapped folks? The list could go on and on with HATE depending on who you are.

The original doctor's comments about rich women with pathetic lives is certainly no one that I would want to treat me-ANGER is all that I can see despite his/her opinion on CLD.

Hello, "Doctor" if you would like further information from other doctors, doctors who support their research and are not afraid of signing their name on what they write feel free to check out the following site of Virginia Starr, MD where there are countless MDs' who agree with us.

Folks, here's the problem with "The Angry Doctor": His penis is the size of a tater tot. It's as simple as that. I mean, C'mon! Wouldn't you be angry if you had a ridiculously tiny penis? A penis barely the size of your thumb? I'm a chic, but even I can imagine how bad that would suck.

That being said, let's get back to chronic Lyme. Im not going to waste my precious time trying to convince you that it is indeed real, and since you think I'm crazy anyways, I may as well let it rip, so here goes: Go eat a dick, you sorry ass piece of shit. And while you're doing that please send me your medical license so I can wipe my ass with it. Quit staring at your junk and wishing it was bigger (IT'S NOT GOING TO GET BIGGER) and instead get up to speed with science you worthless fuck. There. Now I can get back to what I really enjoy - popping pills and googling chronic Lyme. Yep, you had me pegged all right('scuse me while I roll my eyes and vomit at the same time.)Fucking idiot.

Jack, I'm doing it because I don't give a damn what this idiot thinks about me. He thinks we're all crazy, and NOTHING is going to change that short of him coming down with Lyme himself.

I'm sick of playing nice and citing scientific articles that people like this DON'T read, and I'm sick of defending myself against all the crap that gets thrown at me.

I didn't ask for this. I don't WANT to travel out of state to see a doctor, I don't WANT to take 25 pills a day, I don't WANT to belong to a Lyme support group. But it is what it is, and I have to make the best of it. If taking all these pills didn't make me feel better, I wouldn't do it. But they DO make me feel better, so I continue taking them, and that's my right.

Was my previous response appropriate? No. But it's how I feel. To me my response was no less appropriate than his blog about my "pathetic" life. You get what you give, and that's what he got.

I understand that a lot of people are going to completely and totally disagree with me but you are entitled to your opinion. No, I don't think anyone here is crazy. You are all very concerned about your health or the health of a loved one and have a legitimate illness. I am advocating excising good logical thinking and proper exploration into your own heath before making a potentially damaging treatment decision.

Unfortunately for a lot of us, myself included, we make emotion decisions that are often not in the best interest of our health. Is there such thing as "Chronic Lyme", yes. There are multiple published and peer reviewed journal articles and studies that point to its existence. The only problem is, the community got the definition wrong. In these articles and studies, the term "Chronic Lyme Disease" is used to define an untreated infection outside the range of a few years with a suggested treatment protocol of 30 to 60 days of oral antibiotics and in cases where infection persists, 30 days of IV antibiotics if a validated serology test indicates a continuing infection. At this point, for those that had the disease, the damage is done and takes years to heal where symptoms may come and go (what is often called "post-lyme"). This is reasonable, makes physiological sense and is backed up by almost two decades of evidence.

This is where a lot of the problems begin for a lot of people. Most of the laboratory tests used to confirm Lyme disease are not evaluated by the FDA, CDC or any other agency for accuracy. In fact, many of them have been openly discredited as providing false tests and dangerous treatments (See American Biologics as an example).

This brings us to the next stage, lyme literate physicians. Most of these doctors are not lyme literate at all. Propagating these myths are big business for them. Most have patients return once a week or every two weeks. This is a large guaranteed cash flow. They will disregard false or border line tests and proceed with treatment anyway. This can be dangerous for the patient as it can allow the actual disease to go untreated or in some cases cause permanent damage. This is the case for my wife and multiple friends that were being treated by "Lyme Literate" doctors. Ultimately, we requested blood work from another physician who found concrete autoimmune and hormonal issues and treating them caused all symptoms to resolve quickly. If you insist on seeing a lyme literate doctor, please do yourself one favor: Find out what the Dr's specialty and certification is. If it is anything other than "Infectious Disease" you are at a big danger of being scammed. To think about it logically, you wouldn't go to Gynocologist for heart arrhythmia so why would you do the same with a suspected infectious disease.

One of the great ironies is that one of the claims of Lyme is misdiagnosis as autoimmune. Published works and personal experience is showing exactly the opposite. Many of the "chronic lyme" stories follow the progression of various autoimmune disease exactly even the fact that they come and go. Yes, antibiotics over a long term can suppress your immune system to the point that it may decease symptoms from autoimmune diseases but they will come back and usually worse than before.

While I am not suggesting that everyone posting here do not have lyme, many do, I am suggesting you continue to seek out alternate theories. It can't hurt to get your hormones checked, run an auto immune panel or test for related disease such as Lupus, autoimmune Hepatitis, Crone's, Addison's, pituitary dysfunction and Hashimoto's thyroiditis to name a few. All of the above can cause the symptoms that go outside of the CDC criteria (localized joint pain, muscle spasms, migraines, weight gain, weight loss) and some are more common than lyme.

Dealing with chronic diseases can be frustrating, I have ankylosing spondylitis and there have been many times where I wish there was something else I could blame that is curable instead of something that will cause my spine to slowly fuse, but don't make the mistake of developing a belief system instead of using scientific method to find out what is wrong with you.

I do hope you have done more reading on the subject since this post, however.

If a person contracts Lyme, is giving a short course of antibiotics, starts to get better, and then relapses after being taken off the antibiotics, that doesn't mean that have magically gotten an autoimmune disease at the same time they contracted Lyme. Most of these same people, when put on a proper course of antibiotics, will then get better. And I'll not even get into biofilms.

I can understand why someone might be wary in light of the IDSA's opinion on the matter, but if delve a little deeper and do yet more reading, you may, like me, begin to see the full picture. Or so I hope.

Don't forget to include some reading from the opposition- like the ILADS- please.

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I have suffered with Lyme disease since 2002. It is inhumane for physicians or anyone else to downplay the severity and multitude of Lyme disease. My Lyme specialist is taking on 80 new patients per month and has recently re-located to Washington,DC. They have promised him protection from the medical boards or anyone else that is trying to interfere with his treatment programs. I wrote a Lyme Disease Brochure with the help of 2 Lyme disease specialists. Will email to anyone interested. See my video/ Lyme brochure offer at:

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I am a mother of a 7 yr old boy who barely has any eyesight left. we are both Lyme sufferers.I live in TX now, but I lived in NYC for many yrs. My husband and I both survived 9/11.When I hear people like you rant on about things you clearly know nothing about. 2 things come to mind, your confidence and intelligence levels must be the size of a pea, or you have never yourself watched a child you love, suffer and want to do anything in the world to make it better only to be told 1000 more confusing things. The first real glimmer of hope the my son or I have seen has been thru a very arduous diagnosis of Lymes. What makes you so angry at the world that you would crush the hopes of millions truly suffering a pain that a little little man like you could not begin to understand.Do us all a freakin favor and keep your angry doctor crap to yourself, and then do some real soul searching buddy. How in the world do you sleep at night?

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I agree 100% with what you have to say. I was diagnosed with chronic Lyme, had a long course of antibiotics and nothing changed. Later on I found out that I had an autoimmune disease, I treated that and magically my chronic lyme symptoms disappeared. Chronic Lyme is bull and LLMD's rob suffering people of their money. I feel bad for people who go to them.

Maybe they are mislabeling this condition. Chronic lyme or simply untreated tick-related disease? I have a cat that has been sick on and off for three years-respiratory and ocular symptoms but getting worse and worse with each bout. He would take antibiotics for ten days only to have it flare up again after a few weeks. The vet consistently treated it as allergies. Finally we took this cat to an internal medicine vet. BINGO--she ran a series of tests to rule out certain illnesses and we finally diagnosed that he had bartonella and mycoplasm. Now that he has completed his treatment with Zithromax (two months) - he looks and acts like his old self again! Although some MDs readily dismiss the possibility of my catching this -- my symptoms have mirrored his for the exact same time frame and I do plan to find an MD that actually is a GOOD analyst and thinks outside the box. They are worth their weight in gold.

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